Pediatric surgery international · 2026
Renal outcomes and compensatory hypertrophy in survivors of unilateral non-syndromic Wilms tumour: a single-centre cross-sectional study from a tertiary-care institution in India.
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Potturu Monikha, Sehgal Mehak, Sinha Aditi, Jana Manisha, Rangarajan Krithika, Datta Sudip Kumar, Kumar Rakesh, Nilima Nilima, Yadav Devendra Kumar, Goel Prabudh, Agarwala Sandeep, Dhua Anjan Kumar, Srinivas M, Gali Divya, Jain Vishesh
Аннотация
BACKGROUND: This study evaluated renal outcomes and contralateral compensatory hypertrophy in Unilateral Wilms tumour survivors because of a solitary functioning kidney which is vulnerable to hyperfiltration injury.
METHODS: This cross-sectional study (January 2005-May 2023) included children with non-syndromic unilateral Wilms tumour. Renal function was assessed using the modified Schwartz formula (eGFR), 99mTc-DTPA plasma clearance and urinary albumin/creatinine ratio(ACR). Blood pressure was evaluated by office measurement and 24-hour ambulatory blood pressure monitoring (ABPM). Compensatory hypertrophy was assessed by CT volumetric segmentation.
RESULTS: A total of 117 children were included (median age 84 months, IQR 60-120; median follow-up 40.7 months, IQR 16.6-74.3). Reduced eGFR (< 90 ml/min/1.73 m²) was identified in 14 of 116 (12.1%), and reduced 99mTc-DTPA plasma clearance in 38 of 55 (69.1%). Microalbuminuria was identified in 7 of 56 (12.5%), ABPM-detected hypertension in 4 of 48 (8.3%), and compensatory hypertrophy in 36 of 48 (75.0%). Applying the composite definition (any of: low eGFR, low DTPA GFR, microalbuminuria or ABPM-detected hypertension), renal dysfunction was present in 53 of 117 patients (45.3%). In a analysis restricted to the 31 patients who completed all four investigations, renal dysfunction was present in 25 of 31 (80.6%).
CONCLUSION: Isotopic GFR revealed silent nephron injury despite compensatory hypertrophy, with nearly half showing renal dysfunction undetected by creatinine-based eGFR. Creatinine-based eGFR alone risks under-detecting renal dysfunction.
METHODS: This cross-sectional study (January 2005-May 2023) included children with non-syndromic unilateral Wilms tumour. Renal function was assessed using the modified Schwartz formula (eGFR), 99mTc-DTPA plasma clearance and urinary albumin/creatinine ratio(ACR). Blood pressure was evaluated by office measurement and 24-hour ambulatory blood pressure monitoring (ABPM). Compensatory hypertrophy was assessed by CT volumetric segmentation.
RESULTS: A total of 117 children were included (median age 84 months, IQR 60-120; median follow-up 40.7 months, IQR 16.6-74.3). Reduced eGFR (< 90 ml/min/1.73 m²) was identified in 14 of 116 (12.1%), and reduced 99mTc-DTPA plasma clearance in 38 of 55 (69.1%). Microalbuminuria was identified in 7 of 56 (12.5%), ABPM-detected hypertension in 4 of 48 (8.3%), and compensatory hypertrophy in 36 of 48 (75.0%). Applying the composite definition (any of: low eGFR, low DTPA GFR, microalbuminuria or ABPM-detected hypertension), renal dysfunction was present in 53 of 117 patients (45.3%). In a analysis restricted to the 31 patients who completed all four investigations, renal dysfunction was present in 25 of 31 (80.6%).
CONCLUSION: Isotopic GFR revealed silent nephron injury despite compensatory hypertrophy, with nearly half showing renal dysfunction undetected by creatinine-based eGFR. Creatinine-based eGFR alone risks under-detecting renal dysfunction.